Citizens Against Assisted Suicide

Suicide is never death with dignity, and assisted suicide legislation threatens true patient choices at the end of life.

Suspect Abuse?

True Dignity is a grassroots, independent, citizen-led initiative in opposition to assisted suicide. Originally started in 2010 as True Dignity Vermont, our fight has extended beyond Vermont as assisted suicide advocates are pushing their agenda across the U.S. and other nations. Vulnerable people deserve true dignity and compassion at the end of life, not the abandonment of assisted suicide. Killing is not compassion and True Dignity will work to ensure our end-of-life choices respect the dignity of all.

The ethics committee drew its conclusion after carefully and repeatedly weighing the evidence. Its recommendation is remarkable, since it came after the association’s House of Delegates rejected last year’s identical ethics committee advice, instead directing the committee to study the issue yet again. It also came less than two weeks after the association’s second largest constituent group, the American Academy of Family Physicians (AAFP), voted by a two thirds majority to adopt a position of “studied neutrality” on physician assisted suicide and announced its intention to lobby the larger group to adopt the same position.

The full AMA House of Delegates’ meeting convenes on November 12. Members will vote on whether to accept the ethics committee’s recommendation or succumb to the emotions roused by pro-suicide stories; the latter dominated last year’s AMA meeting and have been used in the past to prevail over reason, including, apparently, in the decision-making of AAFP.

Please, all physicians opposed to assisted suicide, and everyone else too, write immediately to [email protected]. In a civil and reasonable way, including giving him your reasons why, let him know of your opposition to assisted suicide and ask that the AMA continue its stated opposition to it.

Barbara Lyons of the Patient Rights Action Fund (609-759-0322, Ext 501) reports this afternoon that not all the news from the American Medical Association’s House of Delegates meeting was as bad as it seemed.

True Dignity reported on June 11, 2018 that the delegates had not accepted the recommendation of the AMA’s ethics board that it refuse to call assisted suicide by the bland, ambiguous, and less morally appalling term “aid in dying” and that it continue its longstanding opposition to AS. The delegates asked the ethics board to spend another year studying the topic and prepare another report for consideration and a vote at the 2019 meeting.

Afterwards, however, they twice voted down a proposal to strike from the AMA’s current official position statement on assisted suicide the sentence opposing its legalization on the grounds that “these practices are fundamentally inconsistent with the physician’s role as healer.”

Thus the AMA’s longtime opposition to AS continues, thanks to a deliberate decision of the delegates. This decision, Lyons writes, “gives us some hope for future votes.”

Numerous news reports and editorials have flooded media outlets over the past two weeks following the tragic deaths by suicide of two celebrities, concurrently with the release of a CDC study confirming a significant rise in suicide nationwide over the past 20 years. There has been speculation about the role played by depression and other mental illness in these deaths, and discussion of social isolation and other psycho-social factors contributing to the rise in the number of suicides overall. There also has been much hand-wringing in the media over their own culpability in the phenomenon of “suicide contagion,” which refers to the spike in suicides that frequently happens after a high-profile suicide. News stories have ended with careful warnings about dealing with depression, paired with referrals to suicide hotlines.

Clearly, as a culture, we view suicide as the tragedy that it is, and we instinctively want to prevent it.

And yet, tucked into one issue of the New York Times last week, alongside multiple pieces covering these tragic deaths, was a starkly contrasting opinion piece by Diane Rehm championing the cause of assisted suicide.

Are we the only ones who have noticed the elephant in the room? When suicide is portrayed as a sort of “noble good” for some, as Rehm does in her editorial, is it any surprise that some depressed people might consider it a reasonable solution to their own suffering?

If we are going to examine all the potential causes behind individual suicides, and an overall rise in the suicide rate, we must consider the role of legal assisted suicide in the contagion phenomenon. Ironically, and perhaps significantly, Oregon first legalized assisted suicide in 1998, exactly one year before the suicide rate nationwide began to rise, according to the CDC. This pattern has been repeated in other states where assisted suicide is legal, and we now know that the trend has spread across the United States as a whole.

As we have written in the past, to promote suicide prevention treatment for some groups while at the same time supporting suicide for one significant and vulnerable population—those who have terminal illnesses—is discrimination of the worst kind. Here in Vermont and in the other States where assisted suicide is legal, the attitude toward the terminally ill has already shifted to one of “helping” them kill themselves, rather than evaluating whether suicide prevention efforts might help them live out their lives in comfort and a state of positive mental health.

Studies reveal that among the elderly, a key reason for suicide is chronic pain. Because the proponents of assisted suicide have worked hard to use the fear of pain as a justification for assisted suicide, it is not hard to imagine that any elderly person with a chronic condition may receive a referral for “aid in dying” rather than suicide prevention treatment, along with better pain management, that might be of greater ultimate help to that person.

Economic worries and concerns about being able to adequately care for loved ones is a key factor among some populations at risk for suicide. It is easy to imagine that a person with a terminal illness, or an elderly person in frail health, might also worry about the depletion of financial resources related to his care; does this person merit suicide prevention treatment, or a prescription to kill himself? Who decides?

The distinction between people whose situations call for “suicide prevention intervention” and those whose expressed desire to die leads to a prescription to die, will become increasingly arbitrary, and the decision to treat may well come down to the subjective judgment of people other than the person who is sick.

Suicide prevention is a laudable cause which we should all support. But beyond that, we need to recognize that legal assisted suicide is, in fact, a contributing factor to suicide and that the price we are paying so that a handful of people with terminal diagnoses can get a doctor’s help to kill themselves is far too high.

Defying the advice of its own ethics committee to continue calling assisted suicide what it really is and to continue opposing it, the full AMA House of Delegates, with a 56% majority, today asked the ethics committee to reconsider its decision, made after two years of study. The ethics committee will issue another report before the 2019 meeting of the House of Delegates.

The AMA’s long time position on assisted suicide has been that it is fundamentally incompatible with the duty of physicians to heal, not harm (https://ama.com.au/system/tdf/documents/AMA%20Position%20Statement%20on%20Euthanasia%20and%20Physician%20Assisted%20Suicide%202016.pdf?file=1&type=node&id=45402). The AMA’s press release emphasizes that this position of opposition remains unchanged (https://www.ama-assn.org/physicians-continue-examination-physician-assisted-suicide).

It also, however, notes the diversity of views among its members and states that these are all morally admirable. The mandate for continued review, especially by such a definitive percentage, means that there is a real possibility that next year’s meeting could change the name “assisted suicide” to “aid in dying” and take a position of neutrality towards it. In the worst scenario, the AMA could give full approval to the practice, but, in True Dignity’s humble opinion, today’s statement regarding diversity of opinion is more likely to foreshadow a position in which the decision to participate in AS is left to the conscience of individual physicians.

The AMA’s opposition has been an important force in slowing the spread of AS. It is ironic that this news comes during a week that has seen two high profile suicide deaths and a report showing a staggeringly large increase in the rate of suicides in 49 states.

The judge ordered that the law should continue in effect for five days, to give the state time to file an appeal of the decision. CA’s attorney has indicated that an emergency appeal will be filed.

No one can know how appellate courts will rule on the law, but True Dignity rejoices that at least one judge has stated clearly that assisted suicide has nothing to do with health care.

News reports indicate that proponents of assisted suicide have embarked on a major fundraising campaign based on their plans to fight this ruling.

The legal group that assisted a group of CA doctors in filing the lawsuit that led to the law’s overturn is Life Legal Defense Foundation. Here is a link through which you can donate to it: https://app.mobilecause.com/form/ygr6Ug. Please consider helping this group continue its important work.

On May 4, 2018, ethicist Wesley Smith reported the good news that the American Medical Association’s Ethics Board, after a two year period of study, has rejected a proposal that the organization withdraw its opposition to assisted suicide through the mechanism of giving it the supposedly more acceptable name, “aid in dying”. The committee pointed out that “aid in dying” is an ambiguous term that could refer to other practices like euthanasia or hospice care. Assisted suicide, the committee said, is exactly that; and it recommended that the association maintain its longstanding opposition to its physician members’ participation it, opposition its report states is based on the fundamental incompatibility between assisting in suicide and the physician’s role as healer as well as on AS’s harmful unintended consequences, some of which have already been demonstrated and others which might not but could happen.

The report acknowledges the contributions of all “stakeholders” whose input informed it; this includes all of us who wrote, but especially physicians like Vermont’s Carol Salazar, whose eloquent letter to the board True Dignity published last summer: http://www.truedignity.org/a-vermont-doctor-writes-to-american-medical-association/. From the bottom of our hearts, True Dignity thanks Dr. Salazar and everyone who contributed to this decision.

With the April 8 signing of Hawaii’s assisted suicide (AS) law, AS is now legal in 6 US states and the District of Columbia.

Since Oregon first legalized AS in 1997, it has taken well-funded, determined, and persistent proponents 21 years of hard fighting to get 6 new legalizations. We should not forget that, thanks to its less well funded but equally persistent and determined opponents, the movement to legalize assisted suicide has experienced more defeats than victories.

We can take comfort from the fact that there has not been a tsunami of AS legalizations, and that there has been real and effective push back. We should congratulate the many people who have worked so hard to keep that from happening, using the tool of reasoned argument. Reason tells us that laws requiring people to tell doctors they want to commit suicide in order to get lethal doses of barbiturates along with instructions and other drugs to use with them to bring about death will result in premature deaths of people against their truly free consent, at best. Reason tells us that every existing law’s requirement that death certificates be falsified to conceal suicide and every existing law’s failure to require witnesses at the time the poison is ingested will enable murder with impunity at worst.

Still, the proponents are well-funded, determined and persistent. They always come back. Their modus operandi is to tell sad stories that mask the utilitarianism behind them. For example, at a committee hearing in NY in 2016, we heard a now-retired state legislator tell the story of how her mother starved herself to death; she wanted to die rather than live in a nursing home, where the daughter said she had to put her after finding that home nursing aides were unreliable. How dare, she asked, did doctors or laws force her mother to stop eating and drinking in order to die, when she could have gotten what she wanted more quickly from AS? Why could she not have what the daughter admitted she only might have wanted, because she never asked for AS? The mother had said she wanted to die rather than live in a nursing home; not living in a nursing home was her choice. Why wasn’t her daughter arguing passionately for better home care or more family leave time? Wouldn’t that have been the reasonable thing to do? This woman’s speech was a classic example of post-reason thinking: utilitarianism (avoiding the trouble and expense of caring for a person at home) barely concealed to the thinker and others under sentimentality. Furthermore this woman was furious, at her mother’s doctor who tried to persuade her to accept tube feeding, and at the opponents of AS among NY legislators and the crowd of professional and grass-roots lobbyists at the hearing. Utilitarian sentimentality morphs quickly into overt hostility when confronted with any argument exposing this type of thinking for what it is. Utilitarians’ no-holds- barred anger seems aimed at creating an environment in which no dissent will be tolerated, in the name of providing a “choice” that actually destroys real choice.

In Vermont, it took many tries over many legislative sessions, over more than a decade, to legalize assisted suicide. The year it was legalized, 2013, legislators told True Dignity that they received many fewer letters of opposition than in the previous session, two years earlier. If we let fatigue, facile optimism inspired by our victories, and the false sense of security purposely created by the structure of existing and proposed laws stop us from fighting, the tsunami that has not happened still can.

We have to continue fighting these initiatives with reasoned, civil letters to the editor, written and personal testimony to legislatures, and attendance at hearings and public meetings. True Dignity recently missed alerting its readers to some opportunities for action, and we will try to do better from now on. Readers are urged to search the internet regularly for opportunities. Don’t hesitate to cross state lines; this affects us all.

Those of us living in states where AS is already legal need to be alert to any evidence of abuse that can get through the veil of secrecy; in Oregon, hints (but only hints)have emerged from personal experiences and a couple of news stories. True Dignity is anxious to report on these. We can be contacted via our Facebook page (https://www.facebook.com/TrueDignityVT/) or by emailing us at [email protected]